There is a lot of emerging data on how behavioral disorders, particularly untreated behavioral disorders, complicate the treatment of medical conditions – frequently resulting in poorer outcomes and increased costs. Some of our recent coverage of this includes Looking Beyond The Superutilizer Umbrella, Comorbid Dementia Increases Medicare Costs By Over 100%, and Reinventing Primary Care – A Challenge For All Health Care Executives. This is the case made for “integrated” care.
But there is another issue that makes an equally compelling case for integrated care – the presence of anxiety disorder or depression that mask an underlying physical health problem. I hadn’t thought much of this issue until I read, When Anxiety or Depression Masks a Medical Problem, in a recent issue of The New York Times. The article refers to the concept of “medical mimics” – medical diseases that can present as mental health issues. A recent article in Psychiatric Times, 7 Medical Illnesses That May Present as Anxiety, lists seven medical issues (and 47 medical illnesses) that can present as anxiety, including cardiac issues, endocrine conditions, gastrointestinal conditions, inflammatory conditions, metabolic conditions, neurologic conditions, and respiratory conditions. The articles point out that neurological disorders, like multiple sclerosis or Parkinson’s disease, often first present as behavioral disorders.
A Psychiatric Times article, Managing Anxiety in the Medically Ill, gives some statistics that provide context to this issue:
- The 12-month prevalence rate of generalized anxiety disorder (GAD) is 3.1% – the lifetime prevalence rate of GAD is 5.7%
- The 12-month prevalence for panic disorder is 2.7% – the lifetime prevalence for panic disorder is 4.7%
- The general prevalence of GAD in consumers seeking primary care services is thought to be 8%
- 25% of chest pain complaints in an emergency department setting are due to panic attacks
From a policy perspective, payers and health plans are focused on the need for better screening for behavioral health disorders in primary care. And, the numbers are poor in terms of screening for depression or addictive disorders. The rate of depression screening in primary care is a good example – What’s With The 4.2%? and Poor Depression Screening Is The Challenge — What’s The Solution?. But medical mimics also point out the need for behavioral health programs to have a framework for identifying medical conditions in consumers presenting with behavioral disorders. This is parallel to the concept of “transactional integration” presented by Ian A. Shaffer, M.D., Vice President & Executive Medical Director of Behavioral Health at Healthfirst, in his opening keynote address at The 2017 OPEN MINDS Strategy & Innovation Institute, Keys To Success With Integrated Care Models For Consumers With Complex Behavioral Disorders.
For more on our latest work on integrated care – both the challenges and the opportunities – check out these resources from the OPEN MINDS Industry Library:
- Hot Spotting, Medical Neighborhoods & New Business Opportunities
- How The ‘Superutilizer Effect’ Has Driven Integrated Care & Changed The Mental Health Landscape
- Is ‘Transactional Integration’ The Key To Integration Success?
- Provider/Health Plan Relationships Moving From Dependence To Interdependence
- Improving The State Of Collaborative Care
To learn more about the Frameworks In Health & Quality disease management program focusing on collaborative care for major depressive disorder, join Heidi Waters, Ph.D., the Director of Outcomes Management at Otsuka Pharmaceutical Development & Commercialization, Inc. and OPEN MINDS Senior Associate Annie Medina, on July 27 at 2:00 pm (EST) for the webinar, Providing Effective Collaborative Care In Major Depressive Disorder: Strategies & Resources From Otsuka’s Frameworks In Health & Quality Program.